Chances are, after reading about high-profile health scares following a measles outbreak at Disneyland in California last January or the latest travel advisory for the Zika virus in Mexico, travel-related health concerns have crossed your mind. To help you better understand which places pose health risks before traveling abroad, and when immunizations are essential to avoid contracting a serious and preventable disease, here's a primer on common vaccinations, with advice from medical experts for a happy and healthy trip.
If You're Headed to Europe …
"I think that most people, when they travel overseas and particularly to developing world countries, they think about exotic diseases," says Dr. Phyllis Kozarsky, Travelers' Health Consultant to the Division of Global Migration and Quarantine at the Centers for Disease Control and Prevention and a professor at Emory University's School of Medicine. But she cautions that it's not necessarily exotic diseases to be concerned about – it's common, everyday things, and especially routine immunizations. Staying up to date on regular immunizations such as measles, mumps and rubella is critical, she explains. Influenza and measles can have very high morbidity rates, especially if the traveler has any underlying diseases, she says. Getting properly vaccinated, even before visiting places like Western Europe, where there have been large outbreaks of measles, is important, she adds.
Dr. David Hamer, director of the Travel Clinic at Boston Medical Center and a professor at the Boston University Schools of Public Health and Medicine, says influenza is the most common and serious health risk U.S. travelers can encounter overseas. He emphasizes the importance of getting vaccinations for measles – whether you were born before or after 1957 – and ensuring that you've had the MMR (measles, mumps and rubella) vaccinations. Places across Europe, excluding Portugal, Spain, the Netherlands and the United Kingdom, also pose the threat of tick-borne encephalitis, which is transferred by ticks in the summer months in wooded areas. While there's no vaccination available in the U.S. for tick-borne encephalitis, there are vaccinations available in Canada and Europe.
If You're Visiting Mexico, Central America or South America …
In Mexico and places throughout Central and South America, it's critical to take effective vaccines for threatening water- and food-borne diseases such as hepatitis A, Hamer says. With heightened risks for water- and food-transmitted infections, getting vaccinated for typhoid is also a smart idea, he adds. And with the latest advisory from the CDC cautioning pregnant women to avoid destinations in the Caribbean and Central and South America to prevent contracting the Zika virus, a tropical mosquito-borne virus that may be linked to brain defects, it's also critical to arm yourself with insect repellent, he says.
"There's the old adage: boil it, peel it or forget it," Kozarsky says. "Basically, if you come to contact with a food or beverage where there is mishandling or any risk of contamination, you're at risk," she adds. "If someone has the capacity to get the hepatitis A vaccine, I think that's really critical." In more exotic destinations in developing world countries, typhoid is very common, she adds. And getting immunized for yellow fever before visiting certain high-risk areas within South America, including Brazil, Bolivia, Columbia, Venezuela, Peru, Colombia, Ecuador, French Guinea, Suriname and Guyana, is also important.
According to Dr. Rajiv Narula, medical director of International Travel Health Consultants, "the reason we all live longer is good water and vaccines." And beyond taking the proper vaccinations, he suggests preparing a health kit stocked with repellents, Band-Aids, sterile syringes and a water purifier. He also cautions that "repellents are crucial," especially those containing DEET, an effective mosquito repellent that uses an odorous compound to detract the insects and prevent mosquito-transmitted diseases in this part of the world as well as Asia.
If You're Traveling to Africa or the Middle East …
Beyond routine immunizations and a vaccination for typhoid, it's important to get vaccinated for hepatitis B, rabies, meningitis and yellow fever in sub-Saharan African destinations like Kenya. It's equally important to ensure that all travelers to malarious regions in Africa take anti-malaria medications. Narula emphasizes the importance of receiving vaccinations for meningitis, especially if you're visiting the region between December and May, the peak season in sub-Saharan Africa to catch meningitis. "The way meningitis works is 10 to 20 percent of people may have it," he says, but they're symptoms may be nonspecific, such as coughing and sneezing once it goes into your circulation, underscoring a serious condition.
While vaccination requirements vary by country, it's essential to receive the polio vaccine if you're traveling to Afghanistan or Pakistan, Hamer says. Another top consideration (and in many countries a requirement for international visitors) is a yellow fever vaccine. While certain destinations such as Ghana require immunizations, he explains, others do not impose an international certificate of vaccination, though it's advisable to get vaccinated before visiting areas across tropical Africa such as Angola, Cameroon and Nigeria.
If You're Going to Asia …
Before traveling to Asia or any other corner of the globe, it's important to factor in individual health conditions, the time of year you're planning to visit, the activities on your itinerary and whether the destinations you'll visit are urban or rural, Kozarsky says. In fact, this is where a travel health provider can really assist. Case in point: A business traveler going to a five-star hotel in Bangkok versus an aid worker at the Thai-Burmese border at a refugee camp have very different needs and are at different risks, she explains. Recommended vaccines may vary even for travelers visiting the same country, depending on whether they're planning an adventurous versus city-based itinerary. This applies to other destinations as well. Your exposure to malaria, for instance, is "not just country-specific," she says. "It's based on a lot of other factors."
The same can be said for Japanese encephalitis, which has been identified in a variety of places across Southeast Asia but is not essential for urban areas. It's better to consider the vaccine during the rainy season, from May to September, Hamer says. And thanks to the new Japanese encephalitis vaccine, the treatment has become very safe and very effective, he adds.
Other Health Risks and Considerations
Beyond region and itinerary, it's critical to consider pre-existing health conditions or chronic illnesses as well as access to medical facilities overseas before you leave for your trip , Kozarsky says. It's also a smart idea to stock up on extra prescriptions before your trip and pack a travel health kit filled with items such as Advil or motion sickness remedies, depending on your itinerary, she adds. And with a different health care system overseas, it's important for travelers to ask their health insurance company or credit card providers what kind of coverage they have overseas and consider supplementing their insurance with evacuation insurance to avoid getting treated at a less-desirable hospital or paying a $100,000 evacuation fee, she says.
When You Should See a Doctor or Specialist …
Unfortunately, not all primary care physicians will have the intel to provide counseling for your specific trip, which is why it's important to solicit guidance from a specialist. "Most people in routine medical training don't spend a lot of time looking at diseases that are indigenous to other countries at certain times of the year," Kozarsky says. Therefore, "they would not carry the special immunizations because it's not reasonable for all providers to have all vaccine, she adds. To find a trusted travel health provider, Hamer recommends online directories like the International Society of Travel Medicine for finding a travel clinic directory with certified specialists as well as the American Society of Tropical Medicine & Hygiene.
To allot for the incubation period, the ideal time to seek a specialist for vaccinations is four to six weeks before your trip, Narula says. "All these things need planning, and people need to understand the risks," he adds, pointing out that most travel-related issues and diseases are preventable, but travelers don't fully grasp the importance of getting vaccinated for prevention. "Travel is good, as long as you protect yourself and you do the right thing," he says.
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